Obstetrics Flashcards
What is premature labour? (gestational age)
24 completed weeks - 36 weeks + 6 days
What are the risk factors for premature labour?
Low socioeconomic status Maternal age (<20 and >35) Genital tract infections PPROM APH Cervical incompetence Congenital uterine abnormalities DM Antiphospholipid syndrome Smoking and substance abuse Previous preterm delivery
How is premature labour diagnosed?
Pregnant women may present with a history of painful contraction and assume they’re in premature labour. Many of these women are experiencing Braxton Hicks contractions.
What are the important questions to ask when taking a history for premature labour?
Duration of contractions and interval bleeding or fluid loss
Full obstetric history
What may be seen on examination for premature labour?
Speculum examination may reveal a dilated cervix and/or amniotic fluid leak
Digital examination should NOT be performed if the membranes have been ruptured due to risk of infection.
If the membranes are intact, a digital examination is the best way of assessing premature labour.
What is the management for premature labour?
Transport pregnant mother to safest facility for delivery
Tocolytic drugs: nifedipine, atosiban (oxytocin receptor antagonist)
Corticosteroids: If mother is 24+0 - 35+6 weeks
Magnesium sulphate for neuroprotection: 24+0 - 29+6, consider for 30+0 - 33+6
Emergency cervical cerclage: 16+0 - 34+0 who have a dilated cervix and unruptured membranes
What is PPROM?
Premature prelabour rupture of membranes
It is the rupture of membranes prior to the onset of labour in a patient who is <37/40.
What is PROM?
It refers to the rupture of membranes occurring prior to the onset of labour and can occur from 37+0 weeks onwards
What are the risk factors for PPROM?
Smoking
Previous preterm delivery
Vaginal bleeding at any time in the pregnancy
Lower genital tract infection
What is the presentation of PPROM?
A history of a “popping sensation” or “gush” with continuous watery liquid draining thereafter. Underwear or pad may be damp.
What investigation would you perform for suspected PPROM?
DO NOT routinely perform a digital examination.
Seeing amniotic fluid draining from the cervix and pooling in the vagina after lying down for 30 minutes is the most accurate test.
USS to check gestation and liquor volume
Temperature monitoring
Foetal monitoring
What is the management for PPROM?
Refer urgently to hospital
Prophylactic antibiotics
Antenatal steroids if between 24+0 and 34+6
Delivery or expectant management
What is the aetiology of miscarriage?
Genetic abnormalities Endocrine factors Maternal illness and infection Abnormal foetal development Uterine abnormalities Incompetent cervix Placental failure Multiple pregnancy PCOS Antiphospholipid syndrome Inherited thrombophilias Poorly controlled DM Poorly controlled thyroid disease
What are the different types of miscarriage?
Threatened miscarriage Inevitable miscarriage Incomplete miscarriage Complete miscarriage Missed miscarriage Recurrent miscarriage (>/= 3)
What are the risk factors for miscarriage?
Maternal age (>30) Smoking Excess alcohol Low pre-pregnancy BMI Paternal age Fertility problems Illicit drug use Uterine surgery/abnormalities Connective tissue disorders Uncontrolled DM Being stressed/anxious
What is the presentation of a miscarriage?
PV bleeding and pain worse than a period
+/- products of conception
What is the differential diagnosis of a miscarriage?
Ectopic pregnancy Implantation bleed Cervical polyp Cervical ectropian Cervicitis/vaginitis Neoplasia Hydatid mole
What investigations would you perform for a suspected miscarriage?
USS (usually transvaginal) Serum hCG (progesterone)
What is the management for a miscarriage?
Access to support, follow up and counselling.
Conservative: urine pregnancy test at 7-14 days and watchful wait
Medical: vaginal misoprostol and a pregnancy test 3 weeks after receiving treatment
Surgical: Vacuum aspiration
What are the risk factors for gestational diabetes?
>35 years old BMI >30 Smoking Previous stillbirth Previous large baby (>4.5 kg) Previous GDM FHx of T2DM More common in Asian, Middle Eastern and African women
What is the pathology of gestational diabetes?
Maternal insulin sensitivity decreases in pregnancy due to human placental lactogen to increase blood glucose to provide enough glucose to the foetus, especially in the 3rd trimester.
How is gestational diabetes usually diagnosed?
Diagnosis is not easy so screening is used for at risk patients as they’re often asymptomatic.
What are the risks of GDM?
Macrosomia Shoulder dystocia Foetal jaundice Congenital defects Increased risk of T2DM late in life Increased risk of childhood obesity Increased risk of tears in the mother T2DM in mother - 50% at 15 years and 50% at 5 years if they required insulin. Increased risk of still birth
What investigation would you perform for GDM?
A 2 hour 75g OGTT
Screening takes place of all mothers with known risk factors at 24-28 weeks gestation